To make changes in something, typically a social, political, or economic institution or practice, in order to improve it.

To implement healthcare reform is to execute massive systematic change that will improve health, no small charge for any government. (See: Affordable Care Act). But Webster doesn’t mention the most important factor in achieving the implementation of reform…

The People!

We cannot implement reform until we acknowledge and appreciate who drives change, and true reform cannot occur without their buy-in. Any country could come up with the best healthcare system in the world, and it will mean nothing if its citizens don’t have enough faith in the system itself to utilize it.

Here in the United States, we love our freedom. We love it so much that we will kill for it, even ourselves. God help the fool who tells us we can’t eat food past 8pm, or who mandates that our sodas come in smaller containers. But when it comes to that heart surgery to unclog our arteries or that medication to lower our blood pressure, you better believe we have a right to demand it. How do you implement healthcare reform in a country that prides itself on life, liberty, and the pursuit of a Big Mac? How do you create pride, faith, and hope in a system people know they need but spend their lives actively avoiding?

Maybe it’s a case of lost hope, specifically in the ability of governments and corporations to deliver. If people are going to buy into a healthcare system, that system better buy into them. I believe that people want to be healthy. (As students of global health we have to believe that to keep our sanity!) I have to believe more than just the fear of going broke due to accident or illness prompts us to generally agree that having health insurance is a good thing. I am less inclined to believe that Americans have bought into the Affordable Care Act, and it is this lack of faith that is paralyzing.

So how do we create it? Since Americans seem hesitant to learn from healthcare models outside our borders (a big part of our problem in the first place), a look at the Veterans Administration healthcare system proves that creating a system that people value is invaluable to the success of health reform. The VA overcame a reputation of bureaucracy, hospital-centered care, and staggering inefficiency in the 80’s and 90’s to become the largest integrated healthcare system in the US today, recognized for leadership in dispensing information, improving performance, caring for more patients with fewer resources, and setting national benchmarks in patient satisfaction.1 The VA is arguably one of the best examples of a healthcare system absolutely dedicated to servicing the needs of its clients. Not only do vets buy into the system because they are entitled to its lifetime benefits, but because they have faith their healthcare providers have bought into them. The VA was able to enroll 800,000 new clients in 2002 because they created a system that people wanted to be a part of.1

I believe that people value health; It’s about time they valued their healthcare. But change won’t happen until the users believe that it will, and it is faith in the reform itself that ultimately decides its fate.

The proof is in the pudding. Or maybe, in this case, the frozen yogurt.